- President Donald Trump on Wednesday signed a bipartisan law expanding access to treatment for opioid misuse, takes aim at people mailing supplies of illicit drugs and provides federal funding for research on non-addictive pain management options.
- The move comes a day after the U.S. Government Accountability Office issued a report identifying 17 public health emergency authorities the federal government could use to address the opioid crisis. Only three are currently being deployed.
- Also this week, CMS rolled out a new payment model that addresses opioid misuse among pregnant women and new mothers.
As the opioid crisis shows no signs of abating, the Trump administration has been criticized for lackluster, underfunded efforts to address the crisis some experts say requires tens of billions of dollars in the next decade to effectively combat.
According to government figures, more than 42,000 people died from opioid-related overdoses in 2016. The Trump administration was slow in responding to the epidemic. It declared the problem a public health emergency a year ago this month, but that action did not release substantial new funds and, as the GAO report shows, was not used to its full potential.
With a rare case of bipartisan support, the opioid legislation expands Medicaid reimbursement for addiction treatment, removes the Institutes for Mental Disease exclusion that bars Medicare payments to large inpatient treatment centers for substance use disorders, increases access to medication-assisted therapy, supports research into nonaddictive pain management alternatives and clamps down on illicit shipments of fentanyl in the U.S.
Speaking Tuesday at a health summit in D.C., HHS Secretary Alex Azar said provisional CDC data shows a downward tilt toward the end of last year into early 2018. He credited federal efforts down to programs at the community level.
But HHS has leveraged just three available authorities to try and deal with the crisis, according to GAO.
The department surveyed more than 13,000 providers to understand prescribing trends for a drug used to treat opioid use disorder, as well as barriers to prescribing it. It waived the public notice period, expediting implementation of two state Medicaid demonstration projects on substance use disorder treatment. And it pushed forward research on opioid use disorder treatments and disseminated information on opioid misuse and abuse.
GAO identified 14 other authorities that are available under the public health emergency and have not been used. Among them are application extensions and waiver of requirements for block grant funding, modifications to the practice of telemedicine and access to the Public Health Emergency Fund and access to National Dislocated Worker grants.
Called Maternal Opioid Misuse (MOM), the new CMS payment model aims to increase care coordination of expectant and postpartum Medicaid beneficiaries with opioid use disorder. The model has a five-year performance period with three distinct model periods: pre-implementation for the first year, transition during the second year and full implementation for years three through five.
CMS said it will issue a Notice of Funding Opportunity for applicants to implement the MOM model in early 2019.
"Too many barriers impede the delivery of well-coordinated, high-quality care to pregnant and postpartum women struggling with opioid misuse, including lack of access to treatment and a shortage of providers in rural areas, where the opioid crisis is especially destructive," Azar said in a statement. "The MOM model will support state Medicaid agencies, front-line providers and healthcare systems to help ensure that mothers and infants afflicted by the opioid epidemic get the care they need."